Don’t treat the mentally ill differently

By John Broderick and Ken Norton

Published: April 15, 2016

Imagine rushing an acutely ill friend or loved one to a local emergency room, having your worst fears confirmed by the doctor, and then being told that it could be days before they can be admitted to the right hospital for treatment because of a waiting list. In the meantime, the critically ill person is left in or near the emergency room receiving less than adequate care and treatment for several more days.

This is not a hypothetical situation; it is the tragic reality faced by many individuals with acute mental illness and their families in New Hampshire.

On March 1, there were 54 individuals in a mental health crisis who were being “boarded” in emergency rooms throughout our state. They included adults and children. For them and their families, adrift in a nightmare, it is a painful, frightening, humiliating and infuriating ordeal. Sadly, it has been going on for over four years and may be worsening, given these most recent numbers.

This unfortunate reality fails the patient who is experiencing acute mental suffering on many fronts — medical, ethical, moral and economic.

It is medically wrong because it delays treatment to reduce mental suffering and promote recovery. Treatment for mental illness, like other medical conditions, has a greater likelihood of positive outcomes the sooner it begins. And like other medical conditions, untreated mental illness can be fatal. Suicide is the second leading cause of death in New Hampshire for people between the ages of 10 and 34.

It is ethically and morally wrong to keep people who need involuntary admission to a New Hampshire Hospital stuck in a hospital emergency room. While state law establishes due process and other legal protections within 72 hours of involuntary admission, many people wait days before the 72-hour clock begins to run.

It seems particularly uncivilized in the 21st century. No other illness is treated this way in the American health care system. And, for those at risk to themselves and others because of mental illness, it is
ethically wrong to force hospitals, their emergency room and their dedicated medical and nursing staff to be left to hold/attend to someone who should not be in their care.

It is also economically unsound. As we know, emergency departments are one of the most costly hospital charges for patients and for hospitals to maintain. These individuals could receive more effective and less costly treatment in other settings.

The reasons for this situation are many and the state is trying to address them. We can stem the flow of people in an acute psychiatric crisis coming to our emergency rooms by enhancing care in their communities. People with mental illness do better in their community and with family support.

The state needs to redouble its efforts to adequately fund community mental health centers and to deploy mobile crisis response teams statewide. But when people experiencing a psychiatric crisis do arrive in the emergency rooms diagnosed as a risk to themselves and others, we have an obligation to find them prompt and appropriate care at NH Hospital.

To his credit, our new Health and Human Services commissioner, Jeff Meyers, convened an emergency meeting to discuss the wait list at NH Hospital. We know this is a concern for the governor as well. While we applaud this important step, New Hampshire desperately needs an updated and comprehensive strategic plan which addresses mental health services across the lifespan. Once New Hampshire solves the wait list issue, which is causing great turmoil for people with acute mental illness and their families, we need to take a fresh look at the safety net and the assistance that New Hampshire provides to those afflicted with the emotional suffering of mental illness. And we have little time to waste.

John Broderick is a former chief justice of the NH Supreme Court. Ken Norton is executive director of NAMI-NH, the state chapter of the National Alliance on Mental Illness.

This article appears in the April 15 2016 issue of New Hampshire Business Review